Hospital characteristics and use of innovative surgical therapies among patients with kidney cancer.
Hospital characteristics and use of innovative surgical therapies among patients with kidney cancer.
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肾癌患者的医院特点和创新手术疗法的使用。
DOI：
10.1097/mlr.0b013e31816099a7
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发表时间：
2008
期刊：
影响因子：
3
通讯作者：
Hollenbeck,BrentK
中科院分区：
文献类型：
--
作者：
Miller,DavidC;Daignault,Stephanie;WolfJr,JStuart;Hafez,KhaledS;Kieran,Kathleen;Dunn,RodneyL;Hollenbeck,BrentK
背景：尽管部分肾切除术和腹腔镜肾癌手术对患者有潜在的好处，但在一些选定的医院，它们的采用是逐渐和集中的。目的：我们评估调整医院结构特征对医院肾切除量与患者接受部分肾切除和/或腹腔镜肾癌手术之间关系的影响程度。研究设计和研究对象：从全国住院患者样本中，我们确定了2003年接受肾癌手术的4943例未加权样本。主要结局指标：我们的主要结局是患者接受了(1)部分肾切除术和/或(2)腹腔镜肾癌手术。结果：我们的加权分析队列包括34,045例。总的来说，16%的患者接受了部分肾切除术，17%的患者接受了腹腔镜手术；在肾切除量大的医院，这一比例分别上升到22%和26%。医院结构特征因肾切除术病例量分层而异。在未经调整的模型中，在肾切除容量最大的医院治疗的患者比在肾切除容量较小的医院治疗的患者更有可能接受部分肾切除术[风险比PN (RR PN) 2.2；95%可信区间（CI）， 1.6-2.8]或腹腔镜手术（RR为2.9;95% CI, 2.0-4.0）。对医院结构差异进行调整后，医院肾切除术体积与使用部分肾切除术或腹腔镜之间的关联分别减弱了60%（调整RR PN为1.4,95% CI为0.9-2.2）和12%（调整RR lap为2.5,95% CI为1.4 - 4.1）。结论：医院环境的改变可能会促进不经常进行肾癌手术的医院更多地采用部分肾切除术。提高腹腔镜应用的努力可能最好是针对外科医生特定的应用障碍。
Background:Despite their potential benefits to patients, the adoption of partial nephrectomy and laparoscopic kidney cancer surgery has been both gradual and concentrated in select hospitals.Objective:We assessed the degree to which adjusting for hospital structural characteristics modifies the association between hospital nephrectomy volume and patient receipt of partial nephrectomy and/or laparoscopic kidney cancer surgery.Research Design and Subjects:From the Nationwide Inpatient Sample, we identified an unweighted sample of 4943 patients who underwent kidney cancer surgery in 2003.Main Outcome Measure:Our primary outcomes were patient receipt of (1) partial nephrectomy and/or (2) laparoscopic kidney cancer surgery.Results:Our weighted analytic cohort comprised 34,045 cases. Overall, 16% of patients received a partial nephrectomy, and 17% underwent laparoscopic surgery; at high-nephrectomy-volume hospitals the proportions increased to 22% and 26%, respectively. Hospital structural characteristics varied across nephrectomy-case volume strata. In unadjusted models, patients treated at hospitals in the highest-nephrectomy-volume tercile were more likely than those treated at low-volume facilities to receive a partial nephrectomy [Risk Ratio PN (RR PN) 2.2; 95% confidence interval (CI), 1.6–2.8] or laparoscopic surgery (RR lap 2.9; 95% CI, 2.0–4.0). Adjusting for differences in hospital structure attenuated the association between hospital nephrectomy volume and use of partial nephrectomy or laparoscopy by 60%(adjusted RR PN 1.4; 95% CI, 0.9–2.2) and 12%(adjusted RR lap 2.5; 95% CI, 1.4–4.1), respectively.Conclusions:Changes to the hospital environment may facilitate greater use of partial nephrectomy at hospitals that infrequently perform kidney cancer surgery. Efforts to increase the uptake of laparoscopy are probably best directed at surgeon-specific adoption barriers.